Global Prevalence of Hepatitis C
Acute hepatitis
C
Chronic hepatitis C Spontaneous clearance
(20%-25%)
Cirrhosis *
(5%-10%at20 years)
Decompensation
Ascites,variceal,bleeding,e Hepatocellular
carcinoma Death
ncephalopathy,jaundice(4
(1%-3%per year) (3%-4%per year)
%-5%per year
1/4
Age
Male sex
Genes
HCC
Liver failure: 5% per year
HCC-incidence: 1-3% per
How to screen
HCV
Positive antibody negative
test
History of NO HCV
HCV infection infection history
HCV RNA
positive negative
test
active HCV infection no active HCV infection
confirmed confirmed
Advise on treatment provide prevention
and management counseling
Diagnosis of acute and chronic HCV
infection
Recommendations Grade of evidence Grade of recommendation
All patients with suspected HCV infection should be tested for anti-HCV Ab in serum or
A 1
plasma as first-line diagnostic test
In cases of suspected acute hepatitis C, in immunocompromised patients and patients on
haemodialysis, serum or plasma HCV RNA testing should be part of A 1
the initial evaluation
If anti-HCV Ab detected, HCV RNA should be determined by a sensitive molecular
A 1
method (LLOD: ≤15 IU/mL)
Anti-HCV Ab+, HCV RNA individuals should be retested for HCV RNA 12 and
A 1
24 weeks later to confirm definitive clearance
In low- and middle-income countries, and specific high-income country settings, a
qualitative HCV RNA assay (LLOD: ≤1000 IU/mL) can be used to provide broad affordable B 2
access to HCV diagnosis and care
Serum or plasma HCV core antigen (a marker of HCV replication) can be used instead of
HCV RNA to diagnose acute or chronic HCV infection when HCV RNA assays are not A 1
available and/or not affordable
EASL CPG HCV. J Hepatol 2018;69:461–511.
Pre-therapeutic assessment
Recommendations Grade of evidence Grade of recommendation
Evaluate contribution of comorbidities to progression of liver disease and implement
A 1
corrective measures
Liver disease severity must be assessed prior to therapy A 1
Identify patients with cirrhosis (F4): adjust treatment accordingly; mandatory
A 1
post-treatment surveillance for HCC
Post-treatment surveillance for HCC must also be performed in patients with advanced
B 1
fibrosis (METAVIR score F3)
Initially, assess fibrosis stage by non-invasive methods; reserve liver biopsy for when there
A 1
is uncertainty or potential additional aetiologies
Renal function (creatinine/eGFR) should be ascertained A 1
Identify extrahepatic manifestations of HCV infection in case of symptoms* A 1
HBV and HAV vaccination should be proposed to patients who are not protected A 1
*Alcoholism, cardiac disease, renal impairment, autoimmunity, genetic or metabolic liver diseases (e.g. genetic haemochromatosis, diabetes
mellitus or obesity) and the possibility of drug-induced hepatotoxicity
EASL CPG HCV. J Hepatol 2018;69:461–511.
Fibrosis Assessment
Does this patient have cirrhosis ?
Risks factors
◦ Long duration of infection
◦ Alcohol , NAFLD, cofactors
◦ Signs of chronic liver disease
◦ Lab findings-Platelet count, AST/ALT ratio, synthetic (INR, albumin) or
excretory (bilirubin) dysfunction
APRI score
i
AST and platelet count
> 1.0 ? Cirrhosis, < 0.5 cirrhosis unlikely
Transient Elastography (Fibroscan)
◦ > 12.5 consider cirrhosis
Goals of therapy
Goal – to cure HCV infection in order to
- Prevent the complications of HCV-related liver and extrahepatic diseases,
including:
Hepatic necroinflammation, fibrosis, cirrhosis, decompensation of cirrhosis,
HCC, severe extrahepatic manifestations and death
- Improve quality of life
- Prevent onward transmission of HCV
EASL CPG HCV. J Hepatol 2018;69:461–511.
*Firstly, Patients
should undergo
the next lab
investigation
before taking
any drug.
*According to the result of lab investigation , physician
can prescribe the treatment for the patient.
For Example:
1)In the following case ,Doctor decided to give the
patient “Double Treatment” which including
(Sofosbovir+daclatasvir).
2)In the following case ,Doctor decided to give the patient
“Triple Treatment” which including
(Sofosbovir+daclatasvir+Ribavirin).
Case no.1
*A.T is 57 years old male. His weight is
59Kg .His Height is170Cm.He suffers from
Hepatitis C with mild ascites(in first U/S on
liver ) ,Then the second U/Son liver
showing (No ascites).
*His lab results showing important
problem
(His Hemoglobin=4.5 Very low value)
Recommendation for this case :
1- Delay taking TTT of Hepatitis C till(Hemoglobin=10
g/dl).
2- To solve this problem
(patient need
blood transfusion
till Hemoglobin =8g/dl).
3-To reach
Hemoglobin=10g/dl ,
give the patient
Erythropoietin vial.
Case no.2
*M.M is 63 years old Female. Her weight is
76Kg .Her Height is155Cm.She suffers
from Hepatitis C
(her first U/S on liver showing
heterogeneous
echopatren hepatic
focal lesion measures
about 7x8 cm at
segment V beside
Splenoectomy) .
Recommendation for this case :
1-case is advised to delay Hepatitis C TTT.
2-Recommended for CT abdomen for
further investigation.
3-Refere to oncology center.
Case no.3
*A.Y is 54 years old Female. Her weight is
82Kg .Her Height is160Cm.She suffers
from *Hepatitis C and renal impairment
(creatinine =1.3 mg/dl)
(U/S on liver showing established cirrhotic
changes)
*Patient is relapsed from 1 year on
regimen(Sofosbovir + Daclatasvir).
*PV=14mm(portal vein dilated).
*Splenoectomy.
*Thick wall bladder (with no stones-means
there is inflammation in bladder).
Recommendation for this case :
1-case is advised to change Hepatitis C TTT
to be (Sofosbovir + Qurevo + Ribavirin).
2-TTT for gall
bladder
inflammation.
Long-term follow up
Assessment for Drug-Drug
interactions
http://www.hep-druginteractions.org
